| NPI | 1134146137 |
|---|---|
| Former Name | KAREN M WIEDEMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA PA18051) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA OPA180510) |
| 363AM0700X Physician Assistant Medical (Licence: CA PA18051) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2012-07-16 |